Vaccinations before or during pregnancy - what to vaccinate against? .

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Why should a woman who is planning a pregnancy think about vaccination? Why is it worth vaccinating before pregnancy? Which vaccines should be taken? Answers to these questions can be found in an interview with Małgorzata Jarosz, MD, PhD - an immunologist from the InviMed infertility treatment clinic in Gdynia.

Why should a woman who is planning a pregnancy undergo vaccination?

Vaccinations protect health, and the health of the mother has a direct impact on the normal course of pregnancy and the development of the foetus. In the case of a pregnant woman, even the flu can result in foetal abnormalities or miscarriage. This is why it is important that there are antibodies in the mother's blood, even before trying to have a baby, to prevent a dangerous disease during pregnancy.

The mother's immunity also has an impact on the infant's later immunity. In the last weeks of pregnancy, the mother passes antibodies to her baby through the placenta, which partially protect the baby from infection in the first months of life.

How does the vaccine work?

The vaccine mimics the first contact with the microorganism, stimulating the body's natural defence mechanisms without causing disease. Antibodies and specialised immune cells formed after first contact with the virus or bacteria help to fight the disease and protect the body from contracting the same disease again.

Vaccines are divided into:

(a) live - contains whole, non-virulent micro-organisms, induces stronger immunity, but is more reactive, is not recommended for pregnant women, and can only be administered in particularly justified exposure situations,

(b) inactivated - contain inactivated (killed) micro-organisms or fragments of micro-organisms, e.g. single proteins, extremely rarely lead to adverse vaccination reactions.

Why vaccinate before pregnancy and not during pregnancy?

Because some infections, if they occur during pregnancy, can be dangerous for the pregnant woman and can also cause infections in the foetus and the newborn. Women planning to become pregnant are advised to be vaccinated and to maintain an interval between vaccination and becoming pregnant.

For women who are already pregnant, vaccination with live vaccines is generally not recommended, as there is a theoretical risk of transmission of the vaccine virus to the foetus. Vaccinations against measles, mumps, rubella, chickenpox or tuberculosis, which are only available in live vaccine form, are contraindicated for pregnant women.

What to vaccinate against before pregnancy?

Rubella vaccination

Among the most commonly recommended vaccinations is vaccination against rubella (as prevention of congenital rubella syndrome, which is associated with numerous foetal defects and often leads to miscarriage). At present, due to the lack of a monovalent (single) vaccine against rubella, vaccination with a combined vaccine against rubella, measles and mumps is recommended. As it is a live vaccine, pregnancy should be avoided for one month after vaccination.

Hepatitis B vaccination

Another vaccination recommended for women planning a pregnancy is hepatitis B vaccination. In the Polish Preventive Vaccination Programme, this vaccination is already performed in childhood in persons born in 1986, so the recommendation applies to women born earlier or those who, for various reasons, did not receive this vaccination in childhood (e.g. born outside Poland).

Influenza vaccination

Before or during pregnancy, a woman should also be vaccinated against influenza, especially if she will still be pregnant during the influenza season. In Poland, this is particularly the period from January to April. Influenza in pregnant women can be severe, requiring hospitalisation and leading to death. Miscarriages, premature births and congenital infections of newborns have also been described.

The inactivated vaccine is completely safe in every trimester of pregnancy and during breastfeeding, and protects especially against complications and severe influenza.

Vaccination against whooping cough

Another dangerous disease especially for newborns is pertussis. It is a highly contagious disease with a high risk of death mainly in the first 6 months of life. Epidemiological studies clearly indicate that the most common source of infection for the child is the immediate environment, mainly the mother. To reduce this risk, current guidelines recommend vaccination with the dTap vaccine (diphtheria, tetanus and pertussis) for women between 27 and 34 weeks of pregnancy.

This is to ensure the protection of the baby in the first weeks of life through the transfer of maternal antibodies across the placenta. The recommendation applies to every pregnancy, regardless of previous dTap vaccination. Recommendations to vaccinate pregnant women against pertussis have been in force in Poland since 2018.

Are vaccines safe?

The safety of vaccines is carefully checked, watched over by institutions such as the National Institute of Medicines, the National Institute of Hygiene and SANEPID, the European Agency for the Registration of Medicinal Products, and the World Health Organisation. The quality of each vaccine batch (lot) is checked before it is released for sale.

It is a fact that the use of vaccines is associated with the risk of adverse vaccine reactions (NOP). However, the risk of a reaction is many times less than the risk associated with contracting an infectious disease - the consequences associated with NOP are many times less threatening to life and health than the consequences of infectious diseases.

Attention!!! All vaccinations should be consulted with your doctor. In the case of planned efforts to have a child with the family doctor, in the case of infertility with the treating doctor, in the case of a pregnant woman with the doctor in charge of the pregnancy.

***

Dr n. med. Malgorzata Jarosz

Specialist immunologist and paediatrician. Graduate of the Medical University of Gdansk with a doctorate in immunology. Medical director of Medicover Centre. In InviMed Gdynia she consults immunologically to couples trying for a baby.